PURPOSE This paper describes the use of a high-performance team model in the leadership of a healthcare construction project with a vision of fostering innovation in the design and building process. This model facilitated the effective implementation of = Lean principles and a joint governance model combining stakeholders under a shared vision. BACKGROUND The healthcare facility discussed is a California healthcare district in San Diego. Because of state seismic safety legislation, the district elected to build a replacement hospital for its tertiary care trauma facility. The organization's leadership decided to pursue a course that demanded innovation in both the design and construction process. The owner, architects, construction manager, and trade contractors adopted a high-performance team model to meet this challenge. CONCLUSIONS AND RECOMMENDATIONS The governance and leadership of a construction project should reflect the design and ultimate intent of the facility. The vision of building the most innovative hospital under constrained resources required the implementation of an innovative approach to leading the construction process.